MRCP2-3314

MRCP2-3314

A 75-year-old male presents to his GP complaining of a crawling sensation in his legs and an urge to move them, especially at night. These symptoms have been present for six months and have worsened over the last two months, causing daytime sleepiness. The patient has a history of hypertension, which is managed with atenolol and ramipril. He quit smoking 10 years ago and drinks 20 units of alcohol per week. He lives alone and has limited family support.

During examination, the patient’s blood pressure was 158/88 mmHg, pulse was 80/min and regular, and heart sounds were normal. Scratch marks were observed on his lower limbs, but tone, power, and reflexes appeared normal with flexor plantar responses. All pulses were present and easily palpable, and abdominal examination was normal.

Investigations revealed a haemoglobin level of 101 g/L (130-180), mean cell volume of 72 fL (80-96), white cell count of 9.2 ×109/L (4-11), and platelets of 285 ×109/L (150-400). Serum sodium was 138 mmol/L (137-144), serum potassium was 4.2 mmol/L (3.5-4.9), serum urea was 5.1 mmol/L (2.5-7.5), serum creatinine was 90 µmol/L (60-110), fasting plasma glucose was 4.5 mmol/L (3-6), and serum cholesterol was 5.1 mmol/L (<5.2). What would be the appropriate management plan for this patient?